Determinants of Diabetic Complication Among Adult Diabetic Patients in Debre Markos Referral Hospital, Northwest Ethiopia, 2018: Unmatched Case Control Study

Abstract

Background

Diabetes mellitus is a group of common metabolic disorders that share the phenotype of hyperglycemia, and are caused by a complex interaction of genetics and environmental factors. Diabetes mellitus produces change in the blood vessels and therefore affects almost every part of the body.

Methods

A hospital-based unmatched case control study was conducted from February 2018 to April 2018 at Debre Markos Referral Hospital. Data were collected from 204 individuals, 136 controls and 68 cases using an interviewer-administered questionnaire and patient chart. Data were entered into EPI-data 3.1 software and exported to SPSS version 21 for analysis. Descriptive analysis including mean, median and proportions was carried out. In bivariate analysis, variables below 0.25 significance level were selected for multivariable analysis. For multivariable analysis, a backward model was selected and 95% confidence interval variables with P-values below 0.05 in multivariable analysis were declared as significant variables.

Results

Of the total respondents, 68 were cases and 136 were controls, with an overall response rate of 98.55%. Of these respondents, 57.4% and 57.8% were males and type 1 diabetic patients, respectively. This study found that ages of 38–47 (AOR= 5.60 (1.62–19.38)) and >47 (AOR=4.81 (1.32–17.5)), income of 1000–1499 (AOR=3.10 (1.05–9.08)), self-reported drug adherence (AOR=5.146 (1.651–16.04)), FBS of 70–130 mg/dL 0.095 (0.022–0.414) and ≥131 mg/dL (0.05 (0.011–0.223)) and type 1 diabetic mellitus (AOR=4.73 (1.765–12.72)) were significantly associated with diabetes mellitus complications.

Conclusion and Recommendations

The study identified important determinants of diabetic complications. Poor glycemic control, poor adherence, and income were found to be modifiable determinants; on the other hand, age and type of diabetic mellitus are non-modifiable determinants of diabetic complications. Clinicians should implement a comprehensive care plan that will address patients’ adherence and glycemic control problems.

Keywords:

• diabetic complication
• glycaemic control
• adherence

Abbreviations

AACE, American Association of Clinical Endocrinologists; BMI, body mass index; DM, diabetes mellitus; DKA, diabetic ketoacidosis; DMRH, Debre Markos Referral Hospital; ESRD, end-stage renal disease; FBG, fasting blood glucose; HgbA1c, glaciated hemoglobin; HHNS, hyperglycemic hyperosmolar non-ketosis coma; HTN, hypertension; IDDM, insulin-dependent diabetes mellitus; IDF; international diabetic federation; Mosm/L, milliosmolality per liter; NIDDM, non-insulin dependent diabetic mellitus; NKF, national kidney foundation; OHA, oral hypoglycemic agents; OPD, outpatient department; RBS, random blood glucose test; SPSS, statical product and service solution; T2DM, type 2 diabetic mellitus; USD, United States dollar; WHO, World Health Organization.

Ethical Approval and Consent to Participate

All participants provided written informed consent, and the study was conducted in accordance with the Declaration of Helsinki. The ethical letter was obtained from Debre Markos University, Health Science College of Ethical review committee. For data quality assurance two days of training were given for data collectors and supervisors prior to data collection. The supervisors monitored the data collection process during the data collection period by checking the completeness of the data and taking the correction on the site of data collection when any problems happened. The principal investigator checked data for its completeness during data entry and the cleaning process.

Data Sharing Statement

The dataset will not be shared in order to protect the participants’ identities.

Acknowledgment

We would like to thank data collectors and supervisors for their great contribution and timely submission of filled questionaires. Our sincere thanks also go to Debre Markos Referral Hospital administrative staff for their permission to participate in this thesis work. We want to extend our heartfelt gratitude to Debre Markos University for giving us all the necessary and available services to conduct this study.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis, and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work. BB conceived and designed the study, performed analysis and interpretation of data. GA and HZ advised and supervised the design conception, analysis, interpretation of data and made critical comments at each step of research. MG, AE, and AA drafted the manuscript. All authors read and approved the final manuscript.

Disclosure

The authors declared no conflict of interest.